the reader as they enter a specific chapter chain reactions within the body, describ- joint mobilization, lymphatic
mphatic techniques,
topic.
Overall, despite some of the limita-
tions mentioned, this book is useful for
healthcare practitioners treating athletes.
It has a good overview of anatomy and
pathophysiology and has a diverse con-
tent spectrum. The book skillfully guides
the reader through a plethora of nerve
and vascular injuries and gives sound
recommendations on proper sports
medicine management related to such
injuries. I would recommend this text to
any healthcare practitioner who manages
athletes with potential nerve and vascu-
lar problems.
Jairus J. Quesnele, BSc, DC
Clinical Sciences Resident
Canadian Memorial Chiropractic
College
Toronto, ON, Canada
ASSESSMENT AND TREATMENT
OF MUSCLE IMBALANCE:
THE JANDA APPROACH
Page P, Frank CC, Lardner R. Cham-
paign, IL: Human Kinetics, 2010, 312
pp, hardcover, illus, $66.00.
Assessment and Treatment of Muscle
Imbalance: The Janda Approach is a well-
written, comprehensive overview of the
works of Vladimir Janda. Anyone whose
clinical practice has benefited from expo-
sure to the Janda Approach through his
various compendiums, videos, courses,
and manuscripts will appreciate this all
inclusive reference.
The authors have broken the book into
4 sections. The first section addresses
the scientific basis for Janda’s approach
to muscle imbalance and they also relate
Janda’s approach to several more con-
temporary schools of thought on muscle
imbalance. They outline Janda’s key
thoughts on the sensorimotor system and
its role in controlling movement and me-
diating muscle imbalances. The authors
of these chapters introduce the concept of
journal of orthopaedic & sports physical therapy | volume 41 | number 10 | october 2011 |
41-10 Book Reviews.indd 799
ing and diagrammatically representing
articular, muscular, and neurological
chains. In the final chapter of this open-
ing section the authors introduce Janda’s
classification of muscles prone to tight-
ness and weakness, as well as his upper
and lower crossed syndromes and layer
syndrome.
The second section of the book, en-
titled “Functional Evaluation of Muscle
Imbalance,” consists of 4 chapters devot-
ed to the visual and palpatory skills need-
ed to fully evaluate movement patterns
and allow a window into the patient’s
sensorimotor system. Chapter 5 deals
with the assessment of posture, balance,
and gait, and the authors present a very
easily adopted algorithm for systematic
postural assessment. Chapter 6 presents
the evaluation of Janda’s 6 basic move-
ment patterns, with an emphasis on the
assessment of the initiation and sequenc-
ing of movement, as well as strength.
Furthermore, the authors describe sever-
al contemporary tests such as the cranio-
cervical flexion test and the transversus
abdominis test. Chapters 7 and 8 discuss
muscle length testing and soft-tissue as-
sessment respectively and nicely relate
these assessments to both muscular ten-
der points and trigger points.
Section 3 covers the treatment of mus-
cle imbalance syndromes. As the author’s
state, “Janda firmly believed that the CNS
and motor system function as one unit,
the sensorimotor system.” In this section
they lay out Janda’s 3 stages of treatment
to normalize function of the sensorimo-
tor system. Chapter 9 deals with normal-
ization of peripheral structures through
the use of techniques directed at the CNS
to elicit peripheral changes (termed “cen-
tral indirect techniques”), as well as tech-
niques applied directly to the peripheral
structures. Central indirect techniques
presented include the Vojta approach,
primal reflex release technique, and the
Feldenkrais method; while local direct
techniques presented include soft tissue
mobilization, neurodynamic techniques,
and orthotic techniques. All of these tech-
niques are very briefly presented and
additional texts and/or training would
be needed to achieve a deeper level of
understanding or proficiency. Chapter
10 covers the restoration of muscle bal-
ance. Factors leading to muscle weakness
and inhibition, as well as muscle tight-
ness and shortening, are discussed, and
techniques to correct these muscle imbal-
ances are presented. Again, a long list of
techniques is presented with little detail
given on any one of the techniques. This
text should not be viewed as a resource
to gain competency in the restoration
of muscle balance, but merely a broad
overview of how the various techniques
presented relate to the Janda System.
Chapter 11 looks at the origins of senso-
rimotor training (SMT) as developed by
Janda, reviews the components of SMT,
and presents the 3 SMT phases (static,
dynamic, and functional).
Section 4 presents an overview of the
role of muscle imbalance and functional
pathology of the sensorimotor system
in common clinical conditions. Chapter
12 examines the cervical region, includ-
ing specific diagnoses of whiplash and
headache. Chapter 13 covers the upper
extremity, outlining specific diagnoses
of shoulder impingement syndrome and
“tennis elbow.” Chapter 14 details lum-
bar pain syndromes, including chronic
low back pain and syndromes related to
the sacroiliac joint. Finally, chapter 15
focuses on the lower extremity, delving
into anterior knee pain and ankle sprains
specifically.
The book is well referenced. However,
the references are not always the most
contemporary ones available. Through-
out the book the authors make good use
of artistic renditions of both structural
and functional anatomy, as well as clinical
snapshots of patients who display mus-
cular imbalance. Furthermore, when de-
scribing clinical evaluative and treatment
techniques, the authors do a nice job pro-
viding concise written descriptions and
799
9/21/2011 4:49:31 PM

clinical pictures of the techniques. The
book includes a thorough index to facili-
tate quick location of content.
Overall, Assessment and Treatment of
Muscle Imbalance: The Janda Approach
provides a thorough, well-organized, and
well-written summary of the Janda ap-
proach to muscle imbalance. The text will
be of interest to anyone who has been ex-
posed to his techniques and writings.
David M Williams, MPT, PhD, ATC,
CSCS
The University of Iowa
Iowa City, IA
THER EX NOTES:
CLINICAL POCKET GUIDE
Kisner C, Colby LA. Philadelphia PA: F.A.
Davis Company, 2011, 281 pp, softcover,
illus, $29.95.
Carolyn Kisner and Lynn Allen Colby
may be well known as the authors of
Therapeutic Exercise: Foundations and
Techniques. In their newer text, Ther Ex
Notes: Clinical Pocket Guide, the authors
create a much more concise, compre-
hensive, and pocket-sized resource for
the rehabilitation specialist, not just the
physical therapist.
Ther Ex Notes is broken down into 8
chapters: an introduction, spine, shoul-
der, elbow/wrist/hand, hip, knee, leg/
ankle/foot, and a balance/plyometrics
chapter, with a reference section for each
chapter. The introductory chapter in-
cludes an abbreviation list corresponding
to the terminology utilized in the text, as
well as exercise interventions, includ-
ing guidelines, precautions, and contra-
indications related to range of motion,
stretching, joint mobilization, neural
tissue mobilization, and resistance and
aerobic exercise. This chapter also in-
cludes generic protocols for treating con-
nective tissue and joint injuries, chronic
inflammatory syndromes, rheumatoid
arthritis, osteoarthritis, and fibromyalgia.
As throughout this text, these protocols
800 | october 2011 | volume 41 | number 10 | journal of orthopaedic & sports physical therapy
41-10 Book Reviews.indd 800
book reviews (continued)
include patient presentations, the corre-
sponding plans of care, as well as inter-
ventions for the various conditions.
The spinal chapter includes guide-
lines for spinal rehabilitation, exercises
to increase range of motion, and nerve
mobilizations. As in all chapters, inter-
ventions are well illustrated, described,
and justified. Exercises to improve mus-
cle performance, such as cervical stabi-
lization, lumbopelvic stabilization, and
dynamic strengthening exercises, are
also included. This chapter also includes
specific treatment approaches, along with
patient presentations and interventions
biased on either extension or flexion, as
well as non–weight-bearing and weight-
bearing approaches. Soft tissue and pos-
tural pain syndrome presentations, with
treatment approaches/interventions, are
also mentioned.
The shoulder chapter discusses guide-
lines for shoulder rehabilitation, exercis-
es to increase range of motion, including
joint mobilizations, mobilization with
movement, and stretching exercises.
The shoulder chapter includes exercises
to improve muscle performance, such
as assistive exercises and isometric/sta-
bilization exercises, as well as open and
closed chain exercises. Ther Ex Notes also
has treatment and progression protocols
for glenohumeral joint arthritis, total
shoulder arthroplasty, painful shoulder
syndromes, subacromial decompression,
full thickness rotator cuff repairs, gleno-
humeral joint stabilization, SLAP lesion
repairs, and nonoperative thoracic outlet
management.
The elbow/wrist/hand chapter dis-
cusses guidelines for rehabilitation ex-
ercises to increase motion, including
joint mobilizations and tendon gliding
exercises. Kisner and Colby also include
treatment protocols for elbow arthritis,
“pushed” and “pulled” elbow, total elbow
arthroplasty, lateral and medial epicon-
dylitis, arthritis of the wrist and hand,
as well as postoperative exercises and
precautions for extensor tendon surgery,
correction of boutonniere deformity, cor-
rection of swan-neck deformity and CMC
joint arthroplasty of the thumb. Protocols
for carpal tunnel nonsurgical and post-
surgical management are described, as
well as complex regional pain syndrome.
The hip chapter discusses guidelines
for hip rehabilitation, exercises to in-
crease motion including joint mobili-
zations, mobilization with movement,
stretching exercises. Also included are
exercises to improve muscle performance
using open and closed chain exercises.
This chapter also includes protocols for
treatment of hip arthritis, total hip ar-
throplasty, hip arthroscopic procedures
(anterior capsulorraphy, microfracture,
and rim trimming), open reduction and
internal fixation, and painful hip syn-
dromes. This chapter includes signs and
symptoms of failure of open reduction
and internal fixation surgery.
The knee chapter discusses standard
guidelines for knee rehabilitation, includ-
ing exercises to improve muscle perfor-
mance, such as isometric exercises, as well
as open and closed chain exercises. This
chapter also includes treatment protocols
for knee joint arthritis, articular cartilage
repair, total knee arthroplasty, patello-
femoral dysfunction, lateral release, ex-
tensor mechanism realignment, meniscal
repair, ligament injuries of the knee, and
cruciate ligament reconstruction.
The leg/ankle/foot chapter discusses
guidelines for ankle rehabilitation, exer-
cises to increase motion, including joint
mobilizations, mobilization with move-
ment, and stretching exercises. Also
included are exercises to improve coordi-
nation and neuromuscular control. This
chapter also includes treatment protocols
for arthritis, repetitive trauma syndrome,
ligamentous injuries (nonoperative and
operative management), and Achilles
tendon repair.
The balance and plyometric chapter
includes concepts and strategies for bal-
ance control, as well as precautions, gen-
eral considerations and parameters to
progress balance training. The authors
also include pictures of balance activi-
9/21/2011 4:49:31 PM